HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED N
Date: S'-/r - : Permit Number:
RECEIVED
Building Permit Application APR 19 2021
Planning and Development Services
Building and Code Regulation Division Commercial Residential �rtme
�rrtt
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: q1Q
.b
Address: (p(aO ( LEE BLVD
Property Tax ID#: a/�i~da�a� dZSd~9 Lot No.
Site Plan Name: JOS f (p ve rra- Block No. /00
Project Name:
C I(e- SL.6 0 l/ 9 eq91-
S
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _ Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2S0 O Utilities: —Sewer _Septic Building Height:
Name Name:
Address: (&0 SEE- gwD Company:
City: rn/27- PIt RCc- State:/—L Address:
Zip Code: 21% Fax: City: State:
Phone No. 7'2Z ZI(o 7 If Zip Code: Fax:
E-Mail: Cotil Phone No
Fill in fee limp a Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
i
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences,walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
SigViature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S1 COUNTY OF
Sworn to(or affirmed) and subs ed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or ✓✓ Online Notarization Physical Presence or Online Notarization
this�Grday of 2017 by this day of 12020 by
Name of person making statement. Name of person making statement.
f
Personally Known OR Produced Identification sonally Known OR Produced Identification
Type of Identification ,as•N ;T e of Identification
Produced a ( . '� duced
1
3
(Signature of Notary Public-Stat Flo ida ) nature of Notary Public-State of Florida )
Commission No.
(Seal)
n z mission No. (Seal)
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REVIEWS FRONT ZONING SUPE tSQIE INS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVI w IEW REVIEW REVIEW REVIEW
DATE a�, o
RECEIVED �J1
DATE
COMPLETED
Rev.
I COUNTY Planning&Development Services Department
Building&Code Regulations
• It I ' A 2300 Virginia Avenue RECEIVED
Fort Pierce,Florida 34982
(772)462-1553 APR 19 2021
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT PQr►n1mrg DaPartment
F.S.489.103(7)EXEMPTIONS St. Lucie County
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you,as the owner of your property,to act as your own contractor even
though you do not have a license. You must provide direct, on-site supervision of the construction yourself. You
may build or improve farm outbuildings, a one-family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building.
You may not hire an unlicensed person to act as your contractor or to supervise people working on your building, it
is your responsibility to make sure that people employed by you have licenses required by state law and byepbunty
or municipal licensing ordinances. Initial V CD
If you sell or lease a building you have built or improved within one year after construction is
complete,then a presumption is created that it was built or improved for sale or lease,which is a vio tydh of
this exemption. Initial- U '
You may not delegate the responsibility for supervising work to a licensed contractor who is not license to
perform the work being done. Your construction must comply with all applicable laws, ordinances,buildin ces,
and zoning regulations. Initial build
I understand that the building official and inspectors are not there to design or give advice on ho tg�tkeet
the minimum code. Initial (J
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license, I maybe responsible and lia a P9 the
cost of the license. Initial U
I understand that if any person that is unlicensed and uninsured gets injured on my construction project-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related h-0-al
In
cost,which could include loss of wages during recovery from their injury. Initial L-/
To qualify for this exemption under this subsection,an owner must personally appear and sign the building
permit application and initial the above
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
XZoi%Department to the Florida S tgDepartment of Professional Regulation. Signed and acknowledged on this
y of of 20 z/
wner/Builder Signature
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this,41 day of q in.%N ,20a, I ,
by'S Ob-. G V^C T A, who is personally known 1 to me,or who has
produced as identification.
/ DEANNA GIV"NS =
h V%V Oar o�• lit State of Florida
Signature of fttary Type or Print Name of Notary '$ NotaryHM 086359
Title:Notary Public Commission Number fit► �d�'' My Comm.Expires Jan 28.2025
SLCPDSD Revised 02/720 °F '
Bonded through National Notary Assn.
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PLANNING& DEVELOPMENT SERVICES DEPARTMENT
Building& Code Regulations Division
iCOUNTY
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553 RECEIVED
FILLED LAND AFFIDAVIT APR 19 1011
Parmittwg Department
St. Lucia County
I,the undersigned, am the owner of the following described property,
\30\-epai - 4a"Ia_acsa-1
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Deveo ment Permit. In
accepting this Final Development Permit, BP Number lk"-% , I acknowledge
that as owner of the above described property, and in accor ce with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
JoSe
Property Owner Name(Please Print)
y - /Q -21
Pr perty Owner Signature Date
STATE OF FLORIDA,COUNTY OF 64-
ACKNOWLEDGED BEFORE ME THIS DAY OF����� .2A_V_
BY'a ft'S4 dr J 4-c f q WHO IS PERSONALLY KNOWN TO ME 12 OR WHO HAS
PRODUCED \ `' AS IDENTIFICATION.
t•,r �,.:y4YIIis
SIGNATURE OF NOTMY PUBLIC TYPE OR PRINT NOTARY
`
%k*k4%S!COMMISSION NUMBER
ray; DEANNAGIV_ti-
"fCf N�6gb ljblic-state of=lorica
Commission#HH 086359
Wv My Comm.Expires Jan 28,2025
"""'Bonded through National Notary Assn,
SLCPDSD Revised04/11/2011
I
COUNTY PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING& CODE REGULATIONS DIVISION
Survey Requirements
The Board of County Commissioner approved a code change that will require a copy of a current sealed
survey when applying for a building permit for a primary structure or a building permit for an accessory
structure with a value exceeding$10,000. This became effective July 1, 1993.
The guidelines are as follows:
No Building Permit shall be issued for development unless a copy of a survey of the property on which
the required activity is to be permitted accompanies the application for building permit. All surveys shall
demonstrate compliance with the Filled Lands Affidavit signed by the Property Owners(refer to St. Lucie
County Land Development Code, Section 7.04.0I.D.3.)and completely depict the following:
1. The location of the proposed development activity.
2. The relationship of the activity under application to all adjacent property lines, and as may be
required for the review of the application, all adjacent structures, improvements or natural
features, including but not limited to the nearest building corners of all adjacent primary and
accessory structures, pools and screened enclosures, fences, sheds, utility easements, wells,septic
systems, driveways, culverts and any landscaping or existing vegetation located along the
property lines.
3. A minimum of two(2)elevations along each roadway on which the proposed activity borders,the
existing ground elevation at the approximate center of the proposed structure,the existing ground
elevation along the side property lines adjacent to the proposed structure,and the proposed
finished floor elevation of the structure under application and finished grades for any adjacent
structures noted above in item 2. The proposed finished floor elevations must be consistent with
the approved Health Department On-Site Sewage Disposal System Construction Permit if on-site
sewage disposal is proposed.
All surveys submitted shall be prepared, signed and sealed by a Florida Registered Land Surveyor, in
accordance with the provisions of Chapter 61G17-6, FAC, except those applications for interior
modifications or construction,roofing permits not involving any structural alteration or additions to the
area covered by the roof surface,or any other permit required activity that does not result in the expansion
of any portion of the existing structures shall not be required to submit a survey. Accessory structures
with a building value of less than ten thousand dollars($10,000)shall not be required to submit a survey,
but shall instead be required to submit a scaled plot plan indicating the location of the accessory structure
and its compliance with minimum setback standards. Copies of original surveys meeting the above
requirements may be submitted with any application for building permit, provided that the survey still
depicts the accurate location of all structures and other improvements on the property.
Per Florida Administrative Code Chapter 61G17-6.006,paragraph 8,additions or deletions to
survey drawings by other than the signing party or parties is prohibited without written consent of
the signing party or parties.
SLCPDSD Rev 06/18/2010
2/9/06 cml